Evidence map›Paper›PMID 36928791›Full record

ArticleJournal of the American Geriatrics Society2023

Using behavioral theory to adapt advance care planning for homeless-experienced older adults in permanent supportive housing.

Sarah E Pajka, Margot Kushel, Margaret A Handley, Pamela Olsen, Brookelle Li, Celeste Enriquez, Lauren Kaplan, Rebecca L Sudore

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sarah E PajkaMedical Student, The Ohio State University College of Medicine, Columbus, Ohio, USA.ORCID 0000-0001-9043-6411
Margot KushelDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.ORCID 0000-0002-1361-6889
Margaret A HandleyDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.
Pamela OlsenDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.
Brookelle LiDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.
Celeste EnriquezDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.
Lauren KaplanDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.
Rebecca L SudoreDepartment of Medicine, The University of California San Francisco, San Francisco, California, USA.

Funding

UCLA Summer Research Training in Aging for Medical Stud*T35AG026736 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Cathy Lee, John C Newman · 2005 to 2026
$3.0M
Mentoring Researchers in Aging in Vulnerable PopulationsK24AG046372 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KUSHEL, MARGOT B · 2015 to 2025
$1.9M
Mentoring Researchers in Advance Care Planning for Underrepresented Older Adults at Risk for Alzheimer’s Disease and Related Dementias and Their CaregiversK24AG054415 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI REBECCA L SUDORE · 2017 to 2026
$1.7M
Adapting Advance Care Planning Tools for Permanent Supportive Housing ResidentsR34AG065600 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KUSHEL, MARGOT B, SUDORE, REBECCA L · 2020 to 2021
$595k
NIA NIH HHS K24 AG046372NIA NIH HHS K24 AG054415NIA NIH HHS R34 AG065600NIA NIH HHS T35 AG026736
6 · The paper itself

Abstract

backgroundOlder adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless-experienced individuals into permanent supportive housing (PSH) may present an opportunity to introduce ACP; but this is unknown. Therefore, we explored staff and resident perceptions of conducting ACP in PSH.

methodsWe conducted semi-structured interviews with PSH staff (n = 13) and tenants (PSH residents) (n = 26) in San Francisco. We used the capability (C), opportunity (O), motivation (M), behavior (COM-B) framework within the Behavior Change Wheel model and the Theoretical Domains Framework (TDF) to inform interviews, categorize themes, and guide qualitative thematic analysis.

resultsThe mean age of PSH residents was 67 (SD = 6.1) years and 52% were women. Of staff, 69% were women. Important COM-B barriers included ACP complexity (C), complicated relationship dynamics (O), resource limitations (O), pessimism (M), variable staff confidence (M), and competing priorities (M). Facilitators included easy-to-use documents/videos, including the PREPARE for Your Care program (C), stability with housing (O), exposure to health crises (O), potential for strong relationships (O), and belief that ACP is impactful (M). Recommendations included adapting materials to the PSH setting, providing staff trainings/scripts, and using optional one-on-one or group sessions.

conclusionsWe identified behavioral determinants related to ACP for formerly chronically homeless older adults in PSH. Future interventions should include using easy-to-use ACP materials and developing resources to educate PSH residents, train staff, and model ACP in groups or one-on-one sessions.

Indexed as

Advance Care PlanningIll-Housed PersonsAgedFemaleHousingHumansMaleSan Franciscoadvance care planninghomelessnessimplementation scienceolder adultspermanent supportive housing

Identifiers

PMID36928791
PMCPMC10440262

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.